1. Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey Matthew Mintz, MD, FACP Associate Professor of Medicine The George Washington University School of Medicine

2. Pre-Clerkship Clinical Skills Courses in the US, 2010: Results of a National Survey Julie Taylor, MD, Alpert Medical School at Brown University Alex Mechaber, MD, University of Miami Miller School of Medicine Ronald Silvestri, MD, Harvard Medical School Preetha Basaviah, MD, Stanford University School of Medicine Steven Durning, MD, Uniformed Services University of the Health Sciences F. Stanford Massie, MD, University of Alabama School of Medicine Sara Tariq, MD, University of Arkansas for Medical Sciences Wendy Madigosky, MD, MSPH, University of Colorado School of Medicine Andrea Flory, MD The George Washington University School of Medicine Felise Milan, MD, Albert Einstein College of Medicine Jeffrey La Rochelle, MD Uniformed Services University of the Health Sciences

3. State of the Union

4. Mid 90’s to Early 2000’s: Interest Groups and Task Forces Form AAMC AAMC Lewis, J., Antonelli, M., Brown, D. D., Haist, S., Hasbrouck, C., McArthur, J., et al. (1993). Report of the introduction to clinical medicine task force. Sponsored by AAMC Group on Educational Affairs Council on Medical Student Education in Pediatrics (COMSEP) Council on Medical Student Education in Pediatrics (COMSEP) Society of Teachers of Family Medicine (STFM) Society of Teachers of Family Medicine (STFM) Clerkship Directors of Internal Medicine (CDIM) Clerkship Directors of Internal Medicine (CDIM)

5. Mary Ann Antonelli, MD FACP Department of Veterans Affairs Pacific Islands Health Care System, Honolulu, HI

6. Earlier Surveys Deloney Linda A. A Comprehensive Overview of Introduction to Clinical Medicine Courses and Course Directors, Chapter IV, November 2003 Deloney Linda A. A Comprehensive Overview of Introduction to Clinical Medicine Courses and Course Directors, Chapter IV, November 2003 Two survey questionnaires were e-mailed to identified curriculum contacts in 126 accredited United States MD-granting medical schools and 16 accredited Canadian medical schools in the spring of 2003. Two survey questionnaires were e-mailed to identified curriculum contacts in 126 accredited United States MD-granting medical schools and 16 accredited Canadian medical schools in the spring of 2003. 48% response rate 48% response rate

7. AAMC Task Force on Clinical Skills Education met in 2003, Recommendations published in 2005

8. AJM Perspective in 2005 Introduction to clinical medicine: A time for consensus and integration-Association of Professors of Medicine Perspective, American Journal of Medicine 2005 Discussed results of CDIM 2003 survey which identified status of ICM course from Clerkship Directors (only some of which were ICM directors)

9. Letter to Editor re: AJM Perspective Mechaber, Bernstein, Dyrbe, Harper, Massie Mechaber, Bernstein, Dyrbe, Harper, Massie 2003 CDIM survey “was a good starting point to begin this dialogue, but a more comprehensive survey of ICM directors is likely warranted.” 2003 CDIM survey “was a good starting point to begin this dialogue, but a more comprehensive survey of ICM directors is likely warranted.” “More important, though, a national forum through an organization with a broad constituency such as the Association of American Medical Colleges is essential to provide more formal recommendations.” “More important, though, a national forum through an organization with a broad constituency such as the Association of American Medical Colleges is essential to provide more formal recommendations.”

10. AAMC Task Force On the Preclerkship Clinical Skills Education of Medical Students 2005 Eugene C. Corbett, Jr., M.D. (Chair) Roger L. Berkow, M.D. Lisa B. Bernstein, M.D. Liselotte N. Dyrbye, M.D. Scott A. Fields, M.D. Maryellen E. Gusic, M.D. William R. Harper, M.D. Starla G. Martinez, M.D. F. Stanford Massie, Jr., M.D. Alex J. Mechaber, M.D. John C. Rogers, M.D., M.P.H, M Ed Matthew R. Thomas, M.D

11. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 AAMC Task Force On the Preclerkship Clinical Skills Education of Medical Students

12. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 1. Adhere to an explicit set of principles to guide the design and implementation of the preclerkship clinical skills curriculum. 2. Implement a clinical curriculum that reflects the developmental nature of skills learning, including the designation of expected levels of skill performance. 3. Adopt explicit competency goals which, in turn, determine the specific skill objectives in the preclerkship curriculum.

13. Recommendations For Clinical Skills Curricula For Undergraduate Medical Education 2008 4. Provide sufficient learning opportunities, using a variety of healthcare settings, that enable students to achieve specified preclerkship objectives. 5. Design and implement strategies to assess students’ achievement of expected clinical skills outcomes. 6. Provide the program elements critical to the success of the preclerkship clinical skills curriculum: leadership, programmatic infrastructure, and the resources required for continuous curricular enhancement.

14. Background Medical Education has changed little since Flexner’s 1910 report, with the introduction Pre-Clerkship Clinical Skills (PCCS) courses being the major exception Medical Education has changed little since Flexner’s 1910 report, with the introduction Pre-Clerkship Clinical Skills (PCCS) courses being the major exception Most schools have (PCCS) courses in years 1 and 2 Most schools have (PCCS) courses in years 1 and 2 Data regarding PCCS course administration, content, and scope are lacking. Data regarding PCCS course administration, content, and scope are lacking. Our purpose was to describe PCCS courses at US medical schools Our purpose was to describe PCCS courses at US medical schools

15. Background/Methods ICM course directors within CDIM initiate a survey ICM course directors within CDIM initiate a survey Julie Taylor, MD from Brown introduces database at NEGEA 2010 Julie Taylor, MD from Brown introduces database at NEGEA 2010 Jim Blatt, MD makes the connection Jim Blatt, MD makes the connection CDIM backs project and agrees to use annual survey to collect additional names CDIM backs project and agrees to use annual survey to collect additional names

16. Methods Several of us (AM, SM, SD, JLR, MM) from CDIM decide to do a national survey (two actually) Several of us (AM, SM, SD, JLR, MM) from CDIM decide to do a national survey (two actually) PCCS Course Directors PCCS Course Directors Curricular Deans Curricular Deans CDIM also agrees to add two questions (name and contact info) to it’s annual survey in 2010 CDIM also agrees to add two questions (name and contact info) to it’s annual survey in 2010

18. Methods Dr. Julie Taylor used direct methods to determine PCCS Course Director names/contact information Dr. Julie Taylor used direct methods to determine PCCS Course Director names/contact information H Handed out contact information sheets at the 2010 NEGEA Called US and Canadian medical and osteopathic schools. By 5/7/2010, this database had contact information from 158 programs, of which there were 229 names and emails available for the 133 AAMC US medical schools.

19. Methods Dr. Jim Blatt makes connection Dr. Jim Blatt makes connection CDIM group and Dr. Taylor combine forces CDIM group and Dr. Taylor combine forces

20. Methods Study was approved by the GWUMC IRB Study was approved by the GWUMC IRB Emails were sent to curricular deans and PCCS course directors with link to an online survey Emails were sent to curricular deans and PCCS course directors with link to an online survey Instructions given in the email and survey to forward to appropriate individual if recipient incorrect Instructions given in the email and survey to forward to appropriate individual if recipient incorrect Reminder email sent to non-respondents Reminder email sent to non-respondents Remaining non-responding schools were contacted directly by research group via phone and/or email Remaining non-responding schools were contacted directly by research group via phone and/or email

21. Methods Two surveys were sent to 133 AAMC member US medical schools. Two surveys were sent to 133 AAMC member US medical schools. First survey was sent to curricular deans First survey was sent to curricular deans Initially, from CurMITT (6/2010) 130/133 names and emails Initially, from CurMITT (6/2010) 130/133 names and emails Direct contact of 3 missing institutions Direct contact of 3 missing institutions Direct contact of 8 “bounce backs” from first sent on 10/11 Direct contact of 8 “bounce backs” from first sent on 10/11 Contact of correct contact from 1 respondent who was not the correct contact. Contact of correct contact from 1 respondent who was not the correct contact.

22. Methods Second survey sent on 10/14 to PCCS course directors identified from: Second survey sent on 10/14 to PCCS course directors identified from: Dr. Taylor’s data base (229 names/emails) Dr. Taylor’s data base (229 names/emails) CurMITT database (77 additional emails from 94/133) CurMITT database (77 additional emails from 94/133) CDIM annual member survey: CDIM annual member survey: 82 (75%) responders generated 26 new names and emails (updated five emails addresses already in the database) 332 total Curricular Dean Survey- 20 new names/emails Curricular Dean Survey- 20 new names/emails Attempted to contact initial non-responding institutions. Attempted to contact initial non-responding institutions.

23. As an aside……

24. Initial response remarkable!! Survey to PCCS course directors sent 10/14/2010 Survey to PCCS course directors sent 10/14/2010 Direct emails to Dr. Mintz suggested overwhelming support Direct emails to Dr. Mintz suggested overwhelming support Impromptu meeting at November 2010 AAMC meeting in Washington, DC sets stage for today’s event. Impromptu meeting at November 2010 AAMC meeting in Washington, DC sets stage for today’s event.

25. Now, back to the study

26. Branched Logic For Course Directors survey, in order to include all directors and co-directors as well as not duplicate results for the same course, branched logic was used For Course Directors survey, in order to include all directors and co-directors as well as not duplicate results for the same course, branched logic was used Baseline demographics and opinion questions were to be completed by all Baseline demographics and opinion questions were to be completed by all Organization and Administration questions completed only by Organization and Administration questions completed only by Overall director Overall director Year 1 and Year 2 director where no overall director existed. Year 1 and Year 2 director where no overall director existed.

27. Results: Curricular Deans 80 of the 133 curricular deans responded (60% response rate) 80 of the 133 curricular deans responded (60% response rate) All schools reported having a PCCS course or content All schools reported having a PCCS course or content 64% PCCS courses managed centrally 64% PCCS courses managed centrally 76% reported that curricular time devoted to PCCS courses in the first two years ranged from 11% to 30% 76% reported that curricular time devoted to PCCS courses in the first two years ranged from 11% to 30% Though content varied considerably, 90% responded that their school’s PCCS course teaches other curricular elements such as professionalism, ethics, and clinical reasoning. Though content varied considerably, 90% responded that their school’s PCCS course teaches other curricular elements such as professionalism, ethics, and clinical reasoning.

28. Results: Curricular Deans

30. Other: Palliative care, cultural competency, health systems, prevention, nutrition

31. Results: Curricular Deans

33. Results: PCCS Course Directors 138 PCCS course directors from 92/133 medical schools responded (69% response rate). 138 completed baseline demographics 138 completed baseline demographics 106 completed organization and administration questions 106 completed organization and administration questions 119 completed opinion questions 119 completed opinion questions

34. Baseline Data or Demographics from PCCS Course Directors

35. Results: Course Name

36. Bedside Diagnosis Essentials of Clinical Medicine Physical Diagnosis and Clinical Integration (Introduction to) Clinical Skills (Essentials of) Clinical Reasoning On Doctoring Foundations of Patient Care/Clinical Practice Competency Based Apprenticeship in Primary Care Patient Physician Society Introduction to the Patient/ to Patient Care Clinical Continuum Doctoring Skills

37. Results: PCCS Course Directors 91% PCCS course directors are physicians (37% general internal medicine, 24% family medicine, 21% subspecialty, and 9% pediatrics). 91% PCCS course directors are physicians (37% general internal medicine, 24% family medicine, 21% subspecialty, and 9% pediatrics). Wide range of years in current position and variety of academic ranks Wide range of years in current position and variety of academic ranks Many have other educational roles Many have other educational roles 36% in other PCCS course 36% in other PCCS course 38% in Clerkship 38% in Clerkship 38% in Residency Program 38% in Residency Program

38. Results: PCCS Course Directors

39. Years in Current Position

40. Academic Rank

41. Course Organization from PCCS Course Directors

42. Course Organization Curriculum organized by organ system (39%), Discipline based (31%) Other (30%) Primary Format didactic (20%), PBL (4%), mix of PBL and didactic (58%), and other (18%) Yearly longitudinal (73%), block module with defined # of weeks (15%), other (12%) 89% stated PCCS course was integrated with basic science courses

43. Results: Learning and Assessment 87% have developed and use core competencies 87% have developed and use core competencies 75% institutions use formal clinical skills curriculum in clinical years 75% institutions use formal clinical skills curriculum in clinical years 89% use OSCE’s in PCCS 89% use OSCE’s in PCCS 81% in Clerkships 81% in Clerkships 88% have clinical skills training lab 88% have clinical skills training lab 83% use in PCCS 83% use in PCCS 65% use in Clerkships 65% use in Clerkships

44. Communication with Clerkship Directors

45. Course Administration from PCCS Course Directors

46. Results: PCCS Course Directors 2/3 PCCS Courses run by 1-3 faculty

47. Results: PCCS Course Directors ~2/3 PCCS Courses need over 50 faculty to run

48. Results: Number of Non-Faculty Administrators (FTE) Three quarters have only 1-3 administrators 1 (24%) 2 (31%) 3(19%) 4(10%) 5(5%) more than 5 (11%)

49. Results: Percent Full Time Faculty

50. PCCS Course Directors Opinions on a National Organization PCCS Course Directors Opinions on a National Organization

51. Results: PCCS Course Directors 87% of PCCS course directors felt that a national organization or resource for PCCS course directors was needed as a way of communicating, sharing, and collaborating. 87% of PCCS course directors felt that a national organization or resource for PCCS course directors was needed as a way of communicating, sharing, and collaborating. Majority believe AAMC national meeting would be a good venue for a live meeting Majority believe AAMC national meeting would be a good venue for a live meeting

52. Results: PCCS Course Directors A national organization for PCCS course directors is needed

53. Results: PCCS Course Directors I would like such an organization for communication (listserve)

54. Results: PCCS Course Directors I would like such an organization for:Agreement Sharing curricular material 94% Method of collaboration for research 91% Share innovations in teaching or other activities 94% Share testing material (OSCE’s) 91% Mentoring 73% Advocacy, i.e. increased funding 78% Establish competency standards 89%

55. Results: PCCS Course Directors Do you attend the AAMC National Meeting? About 50/50

56. Results: PCCS Course Directors Would the AAMC National Meeting be a good venue? Over 2/3 said “yes” ¼ didn’t care Few said “no”

57. Results: PCCS Course Directors Other conference attendance SGIM 30%, CDIM 12%, STFM 21%, COMSEP 3%, No meetings 27% SGIM 30%, CDIM 12%, STFM 21%, COMSEP 3%, No meetings 27% 88% would be likely/very likely to attend AAMC with sessions focused on PCCS course (59% first choice) 88% would be likely/very likely to attend AAMC with sessions focused on PCCS course (59% first choice) Clerkship director meeting in their specialty (66%) Clerkship director meeting in their specialty (66%) Clerkship director meeting not in specialty (14%) Clerkship director meeting not in specialty (14%) Entirely new meeting 72% (25% first choice) Entirely new meeting 72% (25% first choice)

58. Results Summary From the Curricular Deans, PCCS courses: Exist at virtually all US medical schools Exist at virtually all US medical schools Usually managed by the Dean’s office Usually managed by the Dean’s office Account for more than 10% of total curricular time Account for more than 10% of total curricular time Include topics beyond interviewing and physical examination. Include topics beyond interviewing and physical examination.

59. Results Summary PCCS directors: Come from a variety of medical specialties Come from a variety of medical specialties Few supervise many faculty with little administrative support Few supervise many faculty with little administrative support Strongly desire a national forum to collaborate Strongly desire a national forum to collaborate PCCS courses Have a variety of names Have a variety of names Differ in organization and formats Differ in organization and formats Many utilize clinical skills lab Many utilize clinical skills lab

60. Limitations Survey data, not actual curriculum Survey data, not actual curriculum Limited to 133 AAMC schools Limited to 133 AAMC schools Response rate decent, but fell just short of the 70% desired Response rate decent, but fell just short of the 70% desired

61. Thanks Julie Taylor, MD, Alpert Medical School at Brown University Alex Mechaber, MD, University of Miami Miller School of Medicine Ronald Silvestri, MD, Harvard Medical School Preetha Basaviah, MD, Stanford University School of Medicine Steven Durning, MD, Uniformed Services University of the Health Sciences F. Stanford Massie, MD, University of Alabama School of Medicine Sara Tariq, MD, University of Arkansas for Medical Sciences Wendy Madigosky, MD, MSPH, University of Colorado School of Medicine Andrea Flory, MD The George Washington University School of Medicine Felise Milan, MD, Albert Einstein College of Medicine Jeffrey La Rochelle, MD Uniformed Services University of the Health Sciences

62. Additional Thanks Dr. Benjamin Blatt Dr. Benjamin Blatt CDIM CDIM GEA/NEGEA GEA/NEGEA Curricular Deans and PCCS Course Directors Curricular Deans and PCCS Course Directors

63. Questions/Discussion